ZONGHONG SHAO BLOOD DISEASE HOSPITAL CAMS & PUMC ANTITHYMOCYTE GLOBULIN: A CORNERSTONE IN THE TREATMENT OF SEVERE APLASTIC ANEMIA ZONGHONG SHAO BLOOD DISEASE HOSPITAL CAMS & PUMC

MAIN POINTS TO BE TALKED TODAY HISTORY LESSONS THE CONTRIBUTION OF ATG IN THE TREATMENT OF SAA GAP BETREEN DESTINATION AND WHERE WE ARE PROSPECTION HOW TO INCREASE FURTHER THE RESPONSE OF SAA TO ATG

ATG CONTRIBUTION (I) SALVAGING SAA PATIENT’S LIVES

ATG CONTRIBUTION (I) SALVAGING SAA PATIENT’S LIVES

ATG CONTRIBUTION (I) SALVAGING SAA PATIENT’S LIVES BEFORE ATG AFTER ATG

ATG CONTRIBUTION (I) SALVAGING SAA PATIENT’S LIVES

ATG CONTRIBUTION (I) SALVAGING SAA PATIENT’S LIVES

ATG CONTRIBUTION (II) REMINDING PEOPLE OF SAA T-CELL OVERFUNCTION

ATG CONTRIBUTION (II) REMINDING PEOPLE OF SAA T-CELL OVERFUNCTION

ATG CONTRIBUTION (II) REMINDING PEOPLE OF SAA T-CELL OVERFUNCTION

ATG CONTRIBUTION (II) REMINDING PEOPLE OF SAA T-CELL OVERFUNCTION

ATG CONTRIBUTION (II) REMINDING PEOPLE OF SAA T-CELL OVERFUNCTION 骨髓细胞IFN-γ、IL-4m-RNA的表达 组别 例数 IFN-γ（%） IL-4（%） AA组 SAA 16 13（81.3%) 1(6.3%) CAA 11 6 (54.5%) 1(9.1%) 病例对照 PNH 6 0 0 MDS 6 0 0 AL 5 0 1(20.0%) IRP 9 0 4(44.4%) 正常对照 11 0 0

ATG CONTRIBUTION (II) REMINDING PEOPLE OF SAA T-CELL OVERFUNCTION

HISTORY LESSONS ATG CONTRIBUTION A CORNERSTONE THERAPY FOR RESCURING SAA PATIENTS AN PATHOGENIC INDICATOR FOR SAA T-CELL OVERFUNCTION

HISTORY LESSONS GAP BETREEN DESTINATION AND WHERE WE ARE RESPONSE RATE IMPROVEMENT IS IN NEED SAA IS STILL A LETHAL DISEASE IN QUITE MORE MEDICAL CENTERS . EVEN IN THE CENTERS WITH HIGHER QUALITY, THERE ARE STILL 10%~20%OF SAA CASES DIED . ATG USAGE SHOULD BE MODIFIED PROPERLY ATG WAS USED IN SOME NON-T-CELL-OVERFUNCTION RELATED BM FAILURE. ATG WAS USED IN SOME WRONG WAYS, SUCH AS ONCE A WEEK INTRAVEINOUSLY. NO ENOUGH TIME WAS LEFT FOR ATG TO RESTORE SAA BM: THERAPY WAS SHIFTED TOO FREQUENTLY

HOW TO INCREASE FURTHER SAA RESPONSE TO ATG DIAGNOSING SAA CORRECTLY BETTER CONDITIONING THERAPY PROPER ATG USAGE OPTIMUM COMBINING THERAPY ENOUGH SUPPORTIVE THERAPY ENOUGH CONSOLIDATION CLOSELY FOLLOWING UP

DIAGNOSING SAA CORRECTLY Idiopathic Severe pancytopenia Reticulocyte Neutrophil Platelet Severe and broader BM failure T-cell overfunction Excluding other kinds of BM failures

BETTER CONDITIONING THERAPY CONTROLLING INFECTION PATHOGENIC GERMS CULTURES ANTIINFECTION ISOLATING SAA PATIENTS HEMOSTASIS ELEVATING Hb LEVEL KEEPING KEY ORGANS IN GOOD CONDITION

PROPER ATG USAGE ALLERGIC TEST DAILY DOSE COURSE RE-USING 10mg of ATG+NS100cc iv gtt for 1 hour Careful observation and antiallergy medicines in ready No corticosteroids used DAILY DOSE 3~5mg/kg/d equally divided and solved into 2 ×500cc of NS, 500cc iv gtt for 6~8 hours 1mg of pred /kg/d used simultaniusly COURSE 5days RE-USING FOR THOSE WHO HAVE NO ANY RESPONSE TO 1TH COURSE OF ATG AFTER 1 YEAR FOLLOWING UP USING NEW KIND OF ATG (DIFFERENT ANIMAL SPECIES)

OPTIMUM COMBINING THERAPY CYCLOSPORIN LOWER DOSE, LONGER COURSE SERUM LEVEL SERVILLANCE SIDE EFFECTS ANDROGEN HGFs HIGHER DOSE, LONGER COURSE

ENOUGH SUPPORTIVE THERAPY ANTIINFECTION CONTROLLING HEMARRAGES RBC TRANSFUSION NUTRITION SUPPLYMENT PSYCOLOGY CARE

ENOUGH CONSOLIDATION BASED ON THE CLOSELY FOLLOWING UP TIME PBC BM ( INCLUDING BIOPSY AND CULTURE) T-CELL FUNCTION TIME 4 YEARS, NO RELAPSE 3 YEARS, FEW RELAPSE 2 YEARS LESS, SOME RELAPSE

MANY THANKS !